Agenda item

Representatives from the North East and North Cumbria Integrated Care Board (ICB) will be in attendance to provide:

 

·        details of the services available to meet the reproductive health and general health needs of women throughout their life course; and

·        an update on the development of women’s health hubs and how the local hub model will be tailored to meet local population needs.

 

The Director of Place Based Delivery and the Commissioning Delivery Manager from the North East and North Cumbria Integrated Care Board (ICB) were in attendance to provide information on the women’s health programme.

 

The Commissioning Delivery Manager advised that the Department of Health and Social Care (DHSC) had recently published the Women’s Health Strategy for England, which set out 10-year ambitions for boosting the health and wellbeing of women and girls, and for improving how the health and care system listened to women. The strategy encouraged the expansion of women’s health hubs across the country to improve access to services and health outcomes.  The DHSC had recently announced a £25 million investment, nationally, to create new women’s health hubs, as part of the Women’s Health Strategy for England. It was explained that North East and North Cumbria ICB had been allocated £595,000.

 

The scrutiny panel heard that:

 

·        51% of the population were women;

·        59% of women were unpaid carers;

·        78% of the NHS workforce were women; and

·        82% of the social care workforce were women.

 

In terms of national health challenges, the following areas were outlined:

 

·        Although women lived longer than men, women’s heathy life expectancy was less than men.

·        Contraception was difficult to access.

·        45% of pregnancies were unplanned or ambivalent.

·        Abortion rates were rising in women over 22 years old, often because they were unable to access long-acting reversible contraception (LARC), such as the implant or the coil.

·        Maternal mortality was 4x higher in black women and 2x higher in Asian women.

·        Suicide was the leading cause of direct maternal death in the first postnatal year (UK and IE).

·        35% of women who were eligible for screening had not been tested in over three years, which could have saved approximately 1400 lives in England per year.

·        Women from more deprived areas were less likely to take up breast screening.

·        Menopause symptoms lasted for an average duration of 7 years and around a quarter of women suffered severe symptoms.

·        Since 2018:

o   in the most affluent areas of England, there had been a 4-fold increase in the number of women accessing Hormone Replacement Therapy (HRT); and

o   in the most deprived areas of England, there had been a 2.5-fold increase in the number of women accessing HRT.

·        1 in 3 women over 60 years old experienced urinary incontinence. 

·        The symptoms for cardiovascular disease varied for women, and women often received their diagnosis later than men.

·        Osteoporosis and frailty were major causes of morbidity and mortality for women.

 

The priority areas of the Government’s Women’s Health Strategy included:

 

·        Menstrual health and gynaecological conditions;

·        Fertility, pregnancy, pregnancy loss and post-natal support;

·        Menopause;

·        Mental health and wellbeing;

·        Cancers;

·        The health impacts of violence against women and girls; and

·        Healthy aging and long-term conditions.

 

In terms of the regional context, for the area of the North East and North Cumbria, the following information was outlined:

 

·        The gap in life expectancy between the most and least deprived neighbourhoods had increased for both males and females.

·        Women lived longer than men, but on average women lived longer in poor health.

·        Women in the region were not looking after themselves e.g. breast screening uptake.

·        There were wide inequalities in health e.g., HRT.

·        Around 28% of working-age women were economically inactive, compared to 22% of men.

·        Nearly a third of girls and women lived in the 20% most deprived neighbourhoods across England.

·        Levels of access to LARCs had not yet returned to pre-pandemic levels and were lower than England levels.

·        Abortion rates, including under 25s repeat abortions, were on an upward trend.

·        The rate of emergency hospital admissions for intentional self-harm was significantly higher in girls and women.

·        Over a quarter of women (27%) had a diagnosis of anxiety.

·        In 2021, the leading causes of death for all ages of women were cancer, followed by circulatory disease, dementia, and Alzheimer’s,

·        Musculoskeletal conditions, fractures and hospital admissions due to falls, were much more likely to affect women than men.

·        The rate of falls, for women, was significantly higher than the England average.

 

In terms of regional work, the following areas were outlined to the scrutiny panel:

 

·        A regional Women's Health Steering Group, Operational Group and Community of Practice had been established, with Tees Valley representation.

·        A North East and North Cumbria Women’s Health Strategy Conference had been held in October 2023, with the Office for Health Improvement and Disparities (OHID).

·        Work had been undertaken to map the progress of ongoing initiatives, regionally, and liaise with place leads for women’s health.

·        Work had been undertaken to understand population need in the Tees Valley and develop insights by analysing population health management data (across the region, the Tees Valley had been the first area to complete that work).

·        Work had been undertaken to map existing commissioned services across the Tees Valley, against the aims of the Women's Health Strategy. Following completion of the work, gaps in provision, risks, issues and key areas of focus were identified for the Tees Valley.

·        Work had been undertaken with the voluntary community sector to identify other service provision that was available locally.

 

Members were informed that each ICB place, including the Tees Valley, had been invited to bid for the available funding of £595,000, from Government, to develop at least one Women's Health Hub within the North East and North Cumbria footprint. The Tees Valley had submitted a proposal, outlining the key areas of focus, including the menopause and LARC. Unfortunately, the Tees Valley’s bid had been unsuccessful and the funding had been awarded to Sunderland, Gateshead and North Cumbria. Those areas had been awarded the funding to test the concept of the women’s health hubs. It was then hoped that, depending on the outcomes, funding would become available to other areas to improve local services.

 

As part of wider Tees Valley stakeholder engagement, the following key areas had been identified:

 

·        improve Menopause/HRT offer;

·        improve access to contraception - Long Acting Reversible Contraception (LARC) and Emergency Hormonal Contraception (EHC);

·        pessary fitting/removal for prolapse; and

·        increase uptake of cervical screening.

 

It was commented that to strengthen/develop existing service provision there was a need to improve access and deliver clinics for those individuals who were born females, but who no longer identified as women. There was also a need to improve access for women with learning disabilities.

 

The ICB had engaged with HealthWatch to seek feedback on experiences of women’s health services, particularly support for the menopause.

 

The ICB was currently developing the North East and North Cumbria Women’s Health Programme to take forward the implementation of the national strategy. The next steps were outlined to the scrutiny panel:

 

·        Following completion of the current service provision mapping exercise, information and data would be consolidated and analysed to identify opportunities and gaps, which align to local needs and the strategic aims of the Women’s Health Strategy.

·        The Women's Health Collaborative would use collective knowledge to spread and share information and focus on initial priorities and opportunities.

·        A communication, engagement and involvement strategy would be aligned to the development and implementation of the programme.

·        Feedback from HealthWatch would be utilised to inform service improvement/development.

 

A Member raised a query regarding breast cancer diagnosis during pregnancy. In response, the Director of Place Based Delivery advised that the Tees Valley benefitted from symptomatic breast service one stop outpatient provision at the University Hospital of North Tees. Following diagnosis, the majority of patients received treatment/surgery at their local hospital sites. The ICB was focused on promoting collaborative working and the delivery of clear pathways, which aimed to ensure, for instance, that those on a maternal pathway were referred to the diagnostic one stop provision if they found a lump in their breast - to ensure a quick diagnosis. Work was being undertaken to ensure that a consistent offer was available. It was added that, unfortunately, there was not sufficient healthcare capacity to offer a similar service at James Cook University Hospital.

 

A Member raised a query regarding accessibility to services. In response, the Commissioning Delivery Manager advised feedback received had indicated that barriers had been encountered in terms of the accessibility of services. It was commented that the implementation of the hub model would have undoubtedly improved accessibility but unfortunately the Tees Valley had not been successful in securing funding to do that. The Director of Place Based Delivery advised that the Tees Valley was fortunate, as the area had many different health facilities and the service provision available met the needs of the local population of women. However, work was needed to improve accessibility to those services. Available opening hours was one specific area that required further consideration. The ICB was also mindful that there was a need to overcome perceived stigma by re-branding services. A Member commented on the importance of women’s health services being welcoming.

 

A Member raised a query regarding women’s health hubs. In response, the Director of Place Based Delivery advised that women’s health hubs were a concept, which aimed to bring women’s health services together in a more accessible way. It was a network of services that could be accessed by visiting one location. The funding available was for a one-off investment that was ringfenced specifically to co-locate services. The Tees Valley was already fortunate to have an extensive amount of women’s health services that were already grouped together. However, the importance of those services communicating with one another was highlighted, as was the need to ensure that there were not multiple points of contact for women when they were trying to access services. It was highlighted that Sunderland, Gateshead and North Cumbria would be delivering those women’s health services from one particular location.

 

A Member raised a query regarding the outcomes of the town-wide initiative to promote breastfeeding in public places. The Director of Public Health advised that data, in respect of initiation and maintenance rates, would be circulated to the scrutiny panel. The Mayor and Executive Member for Adult Social Care and Public Health commented that in terms of breastfeeding, in Middlesbrough, rates differed drastically between the more affluent areas and the most deprived areas.

 

A Member raised a query regarding maternal mortality being 4x higher in black women. The Commissioning Delivery Manager advised that the data had been reported nationally. It was commented that information would be shared with the scrutiny panel on disparities in outcomes for women, depending on their ethnicity. The Director of Place Based Delivery commented that work was being undertaken by the ICB to track access and equity of provision with an aim to pinpoint cultural barriers and improve access.

 

A Member raised a query regarding the partners that the ICB had engaged with to map current service provision. In response, the Commissioning Delivery Manager advised that a document, detailing the feedback received from partners, would be shared with the scrutiny panel.

 

A Member raised a query about incidences of domestic abuse. In response, the Director of Place Based Delivery advised that specific safeguarding procedures were in place. It was added that data, regarding disclosures to health professionals, would be circulated to the scrutiny panel.

 

A discussion ensued regarding the Women’s Health Strategy. The importance of analysing data and information, to demonstrate/evidence improved outcomes for women, was highlighted.

 

AGREED

 

That the information presented to the scrutiny panel be noted.